Patient-reported outcomes in supportive care

Traditionally, anticancer therapy has focused on eradication of neoplastic tissue, predominantly by invasive and/or toxic treatments. In modern studies, patient-reported outcomes (PROs) have become more common, and give a true picture of toxicity. Increased consideration of subjective patient perspectives of anticancer treatments has allowed a notable shift within supportive oncology. Disparity exists between physician and patient perspectives of symptom severity, despite several common scoring methods. PROs are vital tools in the overall assessment of chronic illnesses, including cancer and associated treatments. Synergistic assessments of objective and subjective observations of symptoms and function are most accurate. PROs include information collected either in a clinic or by a diary system. Patient self-reporting, like any other assessment of health status, is not an absolute measure. Electronic data collection is an increasingly useful way to monitor PROs. Factors that influence quality of life (QOL) are predominantly subjective experiences, and can occur concurrently with pre-existing symptoms, which increases symptom burden. There are several validated systems for assessing PROs; some are concerned with specific conditions like mucositis (Oral Mucositis Weekly Questionnaire [OMDQ]), whereas others cover chronic illness in general (Patient-Reported Outcome Measurement Information System [PROMIS]). The PROMIS framework was developed by the National Health Institute (NHI) to standardize self-reported health measurements within chronic illnesses, including pain, fatigue and emotional distress. The general Assessment of Cancer Therapy (FACT-G) scale was developed to assess many different types of cancer; we will discuss use in oral mucositis as a model. There is more to measuring toxicity than the clinician's objective view of the patient experience. There is still much to be done to validate all the necessary PRO tools so that we can competently measure both toxicity and toxicity-reduction strategies. Current systems to assess PROs continue to have a very positive impact on supportive oncology.Emma Bateman, Dorothy Keef